Provider Demographics
NPI:1346435823
Name:STUPP, HARRIET L (MFT)
Entity Type:Individual
Prefix:MS
First Name:HARRIET
Middle Name:L
Last Name:STUPP
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 CAMINO DEL RIO N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5720
Mailing Address - Country:US
Mailing Address - Phone:619-641-6832
Mailing Address - Fax:877-309-4862
Practice Address - Street 1:3111 CAMINO DEL RIO NORTH
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-641-6832
Practice Address - Fax:877-309-4862
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist